The use of psychotherapy as a treatment for institutionalized mental patients in America has a complex history. The goal of this project is to write a book analyzing certain aspects of this history through a case study of a key figure and a key institution: Frieda Fromm-Reichmann (1889-19957) and Chestnut Lodge Hospital in Rockville, MD. Unlike the somatic perspective of nineteenth century American psychiatry, which viewed insanity as a neurological disease, psychological approaches like Fromme- Reichmann's assumed that psychotic behavior resulted from a particular set of intrapsychic conflicts. Because such an approach allowed for grater specificity in the treatment of mental disturbances, it brought psychiatry closer to the disease model characteristic of such successful specialties as bacteriology and immunology (i.e., the notion that each disease has its own distinct etiology and pattern of symptoms, and thus should have its own form of treatment). In contrast to most histories of psychiatry which use the state hospital as the unit of analysis, this study will highlight the importance of private mental institutions like Chestnut Lodge had the resources to experiment with new and potentially costly modes of treatment. Thus, despite their small size and elite patient population, their role in the history of psychiatry may parallel that of teaching hospitals in the history of medicine. Using a large collection of newly-discovered archival materials, this project will situate Fromm-Reichamann's pioneering theoretical and clinical work and Chestnut Lodge's key role as a center for research and training in the psychoanalytic treatment of psychosis within the broader history of psychological approaches to serious mental disorder. In so doing, it will attempt to shed light on the central question of why there have been repeated shifts between the somatic and psychological perspectives, and whether there are any systematic patterns which explain the dominance of each perspective at particular moments in the history of psychiatry.